Video glasses in endoscopy in children--a preliminary report.

INTRODUCTION: The endoscopy is nowadays the basic diagnostic method in otolaryngology. However, the size and distance of the video display and the location of the monitor continue to be impediments to endoscopy due to the inadequate alignment of the optical axis. AIM: In this study, I evaluate the practical usefulness of video glasses in endoscopy. METHODS: The video glasses, weighing 115 g, which are designed for consumer video home use, consisting of two active LCD color panels with over 300000-pixel resolution. The operator sees the image in front of them, and below the glasses, simply by moving his or her eyes, thus seeing the patient and the field of intervention. 76 patients participated in this study; all of having undergone nasal endoscopy and flexible nasopharyngoscopy. RESULTS: The video glasses allowed me to use an ultra large screen as if there was a 115-cm screen 2 m in front of me. During endoscopy, I could concentrate more on the procedures. There were no complications attributable to the use of the device. CONCLUSION: In my opinion the video glasses may represent a viable alternative to conventional displays for endoscopy, but definition of the specific roles requires further investigation.

Hyaluronic acid gel in the treatment of empty nose syndrome.

BACKGROUND: Empty nose syndrome (ENS) along with atrophic rhinitis are disease entities that are bothersome for patients and difficult for their doctors to treat. The purpose of this study was to evaluate the usefulness of intranasal injection of hyaluronic acid (HA) gel in patients with symptoms of ENS. METHODS: Three patients suffering from ENS and atrophic rhinitis underwent trial treatment consisting of submucosal injections of HA preparations into the inferior nasal concha and under the mucous membrane of the septum. RESULT: As a result of treatment, the patients' symptoms improved for several months and no complications were recorded. CONCLUSION: Because of its simplicity, safety, and fairly good, but impermanent clinical effects, HA injections appear to be worth considering in less severe forms of ENS.

[The minimally invasive rhinoplasty with hyaluronic acid and botulinum toxin in a 49-year old woman]. / Maloinwazyjna rynoplastyka z uzyciem kwasu hialuronowego i toksyny botulinowej u 49-letniej kobiety.

A significant component of human appearance and a major aspect of one's profile depend on the shape of the nose. This shape can be distorted by a variety of factors. To date, treatment options reported have included surgical procedures. Recently minimally invasive procedures for aesthetic medicine have become widely popular, and facial soft tissue augmentation is one of the most common procedures. This article presents a simple and effective alternative using hyaluronic acid and botulinum toxin in a 49-year old female patient in nasal recontouring. We think it is a very effective technique with immediate results. It can be employed in those cases where patients are reluctant to undergo a surgery, or as a primary indication of the correction of minor nose defects.

Benign paroxysmal vertigo of childhood.

OBJECTIVE: To relate the authors' experience to the diagnosis and follow-up of patients with benign paroxysmal vertigo of childhood (BPV) who were followed-up at the Children's Hospital of Bydgoszcz between 1999 and 2004, and to review and discuss controversial issues regarding the disease. METHODS: Among 124 children suffering from vertigo 14 were classified as having BPV. All the children were submitted to differential diagnosis protocol which consisted of meticulous history, otolaryngological, ophthalmological, psychological, neurological examination, biochemical tests and standard neurootological examination including caloric tests. The children were followed-up and the tests were repeated if no improvement was observed. RESULTS: All the children suffered from episodic vertigo of variable intensity and frequency. All of them were neurologically intact. In 8 patients pathologic ENG results were found, only 1 patient with canal paresis could be considered as having peripheral lesion, 7 patients had central/mixed pathology. The follow-up was favorable in majority of patients. Six of them recovered completely, in 6 an improvement was noted and in 2 no improvement was observed. Three patients after remission of BPV attacks developed migraine. One child before development of BPV attacks suffered from paroxysmal torticollis of infancy. CONCLUSIONS: Childhood BPV is a disorder of vestibular system with the onset occurring mainly in preschoolers aged 1-7. Older children with the onset of BPV - like symptoms should be suspected for functional background of the disease. There are no typical ENG features for BPV. The only objective evidence of vestibular dysfunction is the presence of nystagmus during the attack. The disease is probably of vascular origin and there is strong evidence for close relationship between spasmodic torticollis, BPV and migraine.

The influence of birch pollination on the adenoid size in children with intermittent allergic rhinitis.

INTRODUCTION: Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy. MATERIALS AND METHODS: We used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old. Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin prick test results, presence of sIgE in the serum and positive nasal provocation test with birch pollen allergens). The first control group consisted of 14 atopic children hypersensitive to motherwort pollen. The second control group consisted of 15 non-atopic children. The third control group consisted of 10 children hypersensitive to tree pollen, they have got anti-allergic treatment (topical nasal steroid and antihistaminic) a week before birch pollination. In all of the groups the adenoid size was examined before, during and after birch pollination. In the study group, we examined the influence of specific nasal provocation test on the adenoid size too. RESULTS: In most children from the study group (71.4%) we observed the significant increase of adenoid size in endoscopic examination and decrease of nasopharyngeal cavity volume in acoustics rhinometry (92.9%) during the birch pollination. The changes returned after pollination period in most children (90%). In the first and the second control group there were almost no changes observed (p>0.05). The medical treatment used in the third control group avoided the increase of adenoid size during birch pollination season. In the study group there was no statistically significant correlation between the changes in nasopharyngeal volume during the pollination period and the results of nasal provocation test (r=0.18). CONCLUSION: The result of our study suggests that in children with seasonal allergic rhinitis the exposure on the allergenic factor can influence the adenoid size. Properly administered nasal glucocorticoid together with antihistaminic in standard doses can probably avoid this effect.

An analysis of the incidence of adenoid hypertrophy in allergic children.

INTRODUCTION: The adenoidectomy is the most often made operation in small children but the reasons of adenoid hypertrophy are not completely explained. Some researches show that in part of children, allergy can be a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of adenoid hypertrophy in children with different allergic diseases. MATERIAL AND METHODS: Two separate groups of children were examined. The study group consisted of 436 children between 4 and 9 years old with allergic rhinitis and/or bronchial asthma and/or atopic dermatitis hypersensitive to house dust mites (interview, positive skin-prick test results). The control group consisted of 229 non-atopic children (negative interview and skin-prick tests) in the similar age. In the both groups we examined the incidence of adenoid hypertrophy and its dependence of the kind of allergic disease, age, sex, infections, results of skin-prick test and other sensitization. RESULTS: The probability of adenoid hypertrophy was statistically more significant (logistic regression analysis) only in children from the study group with allergic rhinitis. There were no differences in adenoid hypertrophy incidence between children with other allergic diseases and the control group. The children from the study group with adenoid hypertrophy were more often hypersensitive to pollen and moulds allergens than the children without adenoid hypertrophy (chi square test). But there were no differences in the incidence of infection, age, sex and results of skin-prick tests. CONCLUSION: The result of our study suggests that the chance of adenoid hypertrophy in allergic children hypersensitive to dust mites is greater only in them with allergic rhinitis.

[Passive smoking at teenager's home suffering from asthma bronchiale and control at the disease with Asthma Control Test]. / Bierne palenie w domu nastolatka, chorego na astme oskrzelowa a kontrola choroby przy uzyciu testu ACT.

Allergies of the respiratory system are very often at children. Passive smoking may predispose to allergies. The last news shows that smoking at home increases incidence of asthma. It's concerned passive smokers, especially children. Analysis of controlling asthma, exacerbations was made with ACT test. The larger amount of points in ACT test was obtain the better control of asthma was ascertain. Parents were smokers. In this research 164 children and teenagers between 12 and 18 years old from Swiecie and Bydgoszcz, patients Allergologic Outpatients Clinic in 2005-2006, took part. Asthma Control Test was made after the treatment was started. This results show that there is a strong dependence between smoking at home and controlling asthma bronchiale. The correct score--25 points (means that asthma was controlled properly) was at 75% of patients with no smoking at home. At smoker's home every second child has controlled the disease properly. In families where parents smoke a lot every fifth child has no control of the disease. In families, where parents didn't smoke it was only 3%. This analysis shows that there is a strong dependence between frequency of smoking and amounts of points in ACT test. In families where parents smoke rarely children received maximum score in ACT test than in families where patients smoke a lot. There is also dependence between the age of the members of the household and smoking. It is terrifying that there are far more smoking parents at the age of 35 and younger. In this study the ACT was recognized as useful test to control asthma. If smoking parents undergo antinicotine therapy treatment of asthma will be improved.

[The analysis of occurrence of atopic allergy in children with adenoid hypertrophy]. / Analiza wystepowania alergii atopowej u dzieci z przerostem migdalka gardlowego.

UNLABELLED: Although adenoidectomy is the most frequently performed surgical operation in small children, the causes of adenoid hypertrophy are not completely explained. Certain studies indicate that in some children it is an allergy that can constitute a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of atopic allergy in children with adenoid hypertrophy. MATERIAL AND METHODS: Two separate groups of children aged between 4 and 10 years with nasal obstruction were examined. The study group consisted of 796 children with adenoid hypertrophy. The control group consisted of 297 children without adenoid hypertrophy. In all of the children a skin prick test was performed and the frequency of occurrence of typical allergic diseases was estimated. RESULTS: The skin prick test was positive in about 19% of children in both groups under examination (no statistical differences). In children from the study group the allergic rhinitis occurred significantly more often than in the group without hypertrophy (p = 0.0000). The hypersensitivity to dust mites was demonstrated in the study group more often as well (p = 0.0007). The results were confirmed by logistic regression. There were no differences in the frequency of atopic dermatitis and bronchial asthma between both groups compared. CONCLUSIONS: In children with adenoid hypertrophy allergic rhinitis was the most commonly found allergic disease which seems to be the risk factor for adenoid hypertrophy in hypersensitive children.

[The influence of medical treatment of the perennial allergic rhinitis on the adenoid size in children]. / Ocena wplywu leczenia farmakologicznego przewleklego alergicznego niezytu nosa na wielkosc migdalka gardlowego u dzieci.

BACKGROUND: Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy. MATERIAL AND METHODS: We examined changes in clinical symptoms score, and used acoustic rhinometry and endoscopy to evaluate the influence of three months anti-allergic treatment (topical nasal steroid and antihistaminic) on the adenoid size in children with adenoid hypertrophy. Three separate groups of children were examined. The study group consisted of 31 children with adenoid hypertrophy and perennial allergic rhinitis (interview, positive skin-prick test results, presence of sIgE in the serum and positive nasal provocation test with dust allergens). The first control group consisted of 23 atopic children hypersensitive to dust allergens (positive skin-prick test results, presence of sIgE in the serum) with adenoid hypertrophy but without signs of perennial allergic rhinitis and with negative nasal provocation test. This group was not treated. The second control group consisted of 20 non-allergic children with adenoid hypertrophy. The children were treated similar to the children from the study group. RESULTS: In children from the study group we observed the most significant decrease of clinical symptoms and endoscopic adenoid size and increase of nasopharyngeal cavity in acoustics rhinometry after the treatment. In the first control group there were almost no changes and in the second control group, the improvement concern only 25% of children. The medical treatment had however no statistical important influence on the tympanometry results in all the examined groups. CONCLUSION: Properly administered nasal glucocorticoid spray together with antihistaminic in standard doses can significantly reduce adenoidal hypertrophy and considerably eliminate airway obstructive symptoms in children with allergic rhinitis. Likely only in this children the antiallergic treatment can be a useful alternative to surgery.

Seasonal asymptomatic lower airway hyperresponsiveness in patients with allergic rhinitis.

BACKGROUND: Allergic rhinitis is considered a risk factor for bronchial asthma. It therefore seems essential to identify patients threatened with this disease in whom no disturbing bronchial symptoms have occurred. The study's aim was to evaluate the incidence of nonspecific bronchial hyperactivity based on exercise results in pollinosis patients. MATERIAL/METHODS: The study group comprised 27 patients with seasonal allergic rhinitis allergic to tree pollens but without asthma symrptom. Exercise provocation tests were performed before, during, and after completion of the pollination period. During the pollination period, specific IgE (sIgE) and nasal eosinophilia were also determined. Twelve patients allergic to Artemisia pollen made up the control group. The results were also evaluated in relation to desensitization therapy. RESULTS: In the study group a pathological result of the provocation test was obtained in 1 patient (3.7%) before the pollination period, in 7 patients (25.9%) during, and in 4 patients (11.8%) after its completion. The subjects with a positive test result had higher levels of nasal eosinophilia, while there was no relation between the result and sIgE levels. Only one case of positive exercise challenge was identified among the desensitized patients. CONCLUSIONS: During the pollination period, nonspecific bronchial hyperreactivity develops in some patients with seasonal allergic rhinitis; it can be sustained for some time after the disappearance of pollens from the atmosphere and can he identified using an exercise challenge. Incidence of bronchial hyperreactivity in desensitized patients was lower than in those subjected to symptomatic treatment.

[Nasal provocation test with lysine-aspirin in diagnosis of nonallergic rhinitis with eosinophilia]. / Ocena przydatnosci testu donosowej prowokacji z aspiryna lizynowa w diagnostyce przewleklych eozynofilowych niezytów nosa.

Nonallergic rhinitis with eosinophilia is characterized by persistent nasal symptoms without allergy and by a marked eosinophil recruitment in the nasal cavities. The incidence of it is more than 15% among all types of rhinitis. A part of them is caused by nonsteroidal anti-inflammatory drugs hypersensivity. For this study 114 patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 10% of total leukocytes in nasal cytology. In all of them the nasal provocation test with lysine-aspirin was made. The clinical response was evaluated based on nasal symptoms (sneezes, itching, secretion and blockage). The nasal response was measured by acoustic rhinometry. The results of the test was positive in 19 cases, mostly in patients with nasal polyps, bronchial asthma and higher level of nasal eosinophilia (differences statistically significant). The count of nasal eosinophilia corresponded better with the decrease of nasal volume in acoustic rhinometry (r = 0,84) then with the clinical score (r = 0,52). The nasal challenge was well tolerated by almost all subjects. We conclude that the nasal challenge with lysine-aspirin is safe and can be helpful as a diagnostic test in patients with nonallergic rhinitis with eosinophilia.

[The analysis of incidence of adenoid hypertrophy in children hypersensitive to dust mites]. / Analiza czestosci wystepowania przerostu migdalka gardlowego u dzieci uczulonych na roztocze kurzu domowego.

UNLABELLED: The adenoidectomy is the most often made operation in small children but the reasons of adenoid hypertrophy are not completely explain. Some researches show that in part of children allergy can be a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of adenoid hypertrophy in children with different allergic diseases. MATERIAL AND METHODS: Two separate groups of children were examined. The study group consisted of 436 children between 4 and 9 years old with allergic rhinitis and/or bronchial asthma and/or atopic dermatitis hypersensitive to house dust mites (interview, positive skin-prick test results). The control group consisted of 229 non-atopic children (negative interview and skin-prick tests) in the similar age. In the both groups we examined the incidence of adenoid hypertrophy and its dependence of the kind of allergic disease, age, sex, infections, results of skin-prick test and other sensitisation. RESULTS: The probability of adenoid hypertrophy was statistically more significant (logistic regression analysis) only in children from the study group with allergic rhinitis. There were no differences in adenoid hypertrophy incidence between children with other allergic diseases and the control group. The children from the study group with adenoid hypertrophy were more often hypersensitive to pollen and moulds allergens than the children without adenoid hypertrophy (chi square test). But there were no differences in the incidence of infection, age, sex and results of skin-prick tests. CONCLUSION: The result of our study suggests that the chance of adenoid hypertrophy in allergic children hypersensitive to dust mites is greater only in them with allergic rhinitis.

[The influence of tree pollen on the adenoid size in children with periodic (seasonal) allergic rhinitis]. / Ocena wplywu alergenów pylku drzew na wielkosc migdalka gardlowego u dzieci z alergicznym okresowym (sezonowym) niezytem nosa.

INTRODUCTION: Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy. MATERIAL AND METHODS: We used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old. Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin-prick test results, presence of sIgE in the serum and positive nasal provocation test with birch pollen allergens). The first control group consisted of 14 atopic children hypersensitive to motherwort pollen. The second control group consisted of 15 non-atopic children. The third control group consisted of 10 children hypersensitive to tree pollen, they have got antiallergic treatment (topical nasal steroid and antihistaminic) a week before birch pollination. In all of the groups the adenoid size was examined before, during and after birch pollination. In the study group we examined the influence of specific nasal provocation test on the adenoid size too. RESULTS: In most children from the study group (71.4%) we observed the significant increase of adenoid size in endoscopic examination and decrease of nasopharyngeal cavity volume in acoustics rhinometry (92.9%) during the birch pollination. The changes returned after pollination period in most children (90%). In the first and the second control group there were almost no changes observed (p > 0.05). The medical treatment used in the third control group avoided the increase of adenoid size during birch pollination season. In the study group there was no statistically significant correlation between the changes in nasopharyngeal volume during the pollination period and the results of nasal provocation test (r = 0.18). CONCLUSION: The result of our study suggests that in children with seasonal allergic rhinitis the exposure on the allergenic factor can influence the adenoid size. Properly administered nasal glucocorticoid together with antihistaminic in standard doses can probably avoid this effect.

[Allergic tonsillitis: myth or reality]. / Alergiczne zapalenie migdalków--mit czy rzeczywistosc.

The tonsils are part of Waldeyer's ring, the basic function of which is antibody formation; they react later against a wide variety of antigens. Allergic sensitization of the airways occurs not only in the mucosa of the afflicted organ, but also in the lymphatic stations draining these structures. The lymphatic structures closest to the nasal mucosa in humans are the adenoids and tonsils. Adenoidal, nasal, and middle ear diseases are frequent health problems in young children. Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is also a frequent indication for surgery. Research done with respect to Waldeyer's ring in people dealing concurrently with allergy is a seldom subject in medical literature, both Polish and world wide. The study shows that allergy and sensitivity to different kinds of allergens are risk factors for adenoid hypertrophy (AH) in children. Histopathological and immunohistochemical studies confirms that tonsil dendritic cells, macrophages, eosinophils, and mast cells are involved in and are important in allergic tonsillitis. Ig synthesis and switching also occur in the adenoid and tonsils. Early treatment of allergic diseases may help reduce the occurrence of AH. Properly administered nasal steroids and antihistamines can reduce adenoidal hypertrophy and nasal airway obstructive symptoms in atopic children.

[A case of labyrinthitis due to congenital cholesteatoma in a child]. / Przypadek zapalenia blednika w przebiegu perlaka wrodzonego u dziecka.

A rare case of congenital cholesteatoma as a cause of acute labyrinthitis is presented in the report. 14-years old boy was operated due to labyrinthitis caused by a huge cholesteatoma discovered behind intact tympanic membrane. On the first examination the symptoms indicated lack of right inner ear function, so unfortunately the referral was to late and the patient resulted in the dead ear. The diagnosis of congenital cholesteatoma as well as treatment of the entity and its subsequent complications is discussed in the report.

Possible induction of oral allergy syndrome during specific immunotherapy in patients sensitive to tree pollen.

BACKGROUND: Many studies have shown that specific immunotherapy may prevent the development of allergies to new allergens. Recently, however, there have been sporadic reports on the possibility of new allergies developing during immunotherapy. The aim of this study was to evaluate the possibility of the occurrence of food allergy and changes of sIgE concentration in patients sensitive to tree pollen during specific immunotherapy. MATERIAL/METHODS: We examined 12 patients subjected to desensitization treatment of pollinosis caused by allergy to the pollen of Betulaceae trees, in whom only Bet v 1 sIgE was found in serum prior to immunotherapy. The control group included 8 allergic patients who did not consent to this treatment. RESULTS: Bet v 2 sIgE was detected after 6 months in 3 patients (25%) and after 18 months in another 2 patients (41.7% total). In 2 cases, oral allergy syndrome (OAS) occurred in the course of therapy. These findings were accompanied by a concomitant decrease in nasal and ocular allergic signs during the birch pollen season in the overwhelming majority of patients (91.7%). In the control group, no serum occurrence of Bet v 2 sIgE was found during the 18-month observation period. Although no OAS signs appeared in any patient, the symptomatic intensity of pollinosis was not reduced. CONCLUSIONS: Due to the limitations of currently used vaccines, new allergies may be induced during immunotherapy. In sporadic cases these may be accompanied by the occurrence of specific clinical manifestations, usually mild.

[The results of extra diagnostic methods in patients allergic to dust mites treated by specific immunotherapy]. / Wyniki badan dodatkowych u chorych uczulonych na roztocze kurzu domowego leczonych za pomoca immunoterapii swoistej.

BACKGROUND: In addition to allergen elimination, specific immunotherapy remains the only recognized causal treatment of allergic diseases. Nevertheless, there are no commonly accepted parameters and tests allowing for the evaluation and prediction of its efficacy. The aim of this study was to evaluate the results of readily available supplemental allergy tests and to attempt to associate those findings with the outcome of therapy for desensitized patients. METHODS: This study was conducted in a group of 22 patients receiving specific immunotherapy for perennial allergic rhinitis to dust mites. The results of skin prick tests, sIgE levels, nasal eosinophilia levels as well as specific nasal provocation tests measured by acoustic rhinometry were compared prior to desensitization and two years following the therapy. The control group comprised 17 allergic patients treated without immunotherapy. RESULTS: Apart from the confirmation of immunotherapy efficacy, a positive correlation between its results and the results of the nasal provocation test (correlation coefficient r = 0.85) were demonstrated in this study. No relationship was however found between the obtained result and the results of skin prick tests (r = 0.57) and serum sIgE levels (r = 0.59) or nasal eosinophilia (r = 0.57). The result of acoustic rhinometry corresponded well with clinical manifestations observed in nasal provocation tests. CONCLUSIONS: The specific nasal provocation test is an easy method that may be used for monitoring the efficacy of immunotherapy, and acoustic rhinometry is a good method for measuring its results.

[Tympanoplasty decision making in a child with HIV contamination--case report]. / Problem wykonywania tympanoplastyki u dzieci zakazonych wirusem HIV--na podstawie przypadku.

Otologic problems are infrequent in HIV patients. Authors present the case of chronic otitis media in the HIV infected child. The patient with significant hearing loss, and prolonged aural discharge, resistant to local and systemic antibiotic treatment was treated surgically. Mastoidectomy with myringoplasty was performed. The substantial hearing improvement has been obtained, ear discharge never returned. However due to episodes of chronic otitis media with effusion ear drainage with tympanostomy tubes, after initial surgery have been performed two times. The controversies regarding surgery decision-making in this group of patients are discussed.

[The results of exercise challenge in patients with seasonal allergic rhinitis]. / Ocena wyników próby wysilkowej u chorych z alergicznym sezonowym niezytem nosa.

BACKGROUND: Allergic rhinitis is considered a risk factor for the future development of bronchial asthma. It therefore seems essential to identify patients who are threatened with this disease and in whom no disturbing bronchial symptoms have already occurred. The aim of this study was to evaluate the incidence of nonspecific bronchial hyperactivity based upon exercise results of patients with pollinosis. INVESTIGATED GROUP: The study encompassed 27 patients with seasonal allergic rhinitis allergic to tree pollens, but without symptoms of asthma. Exercise provocation test were performed in patients in the period before, during and after completion of the pollination period. Additionally, during the pollination period sIgE and nasal eosinophilia were determined. The control group was composed of 12 patients allergic to Artemisia pollen. RESULTS: In the study group, a pathological result of provocation test was obtained in 1 patient (3.7%) before the pollination period, in 7 patients (25.9%) during and in 4 patients (14.8%) after completion of the pollination period. Subjects with positive test result had higher levels of nasal eosinophilia, while there was no relation between its result and sIgE levels. Only one case of positive exercise challenge was identified among desensitized patients. CONCLUSIONS: During the pollination period nonspecific bronchial hyperreactivity develops in some patients with seasonal allergic rhinitis; it can be sustained for some time after disappearance of pollens from the atmosphere and can be identified using an exercise challenge. Incidence of bronchial hyperreactivity in desensitized patients was lower than in those subjected to symptomatic treatment.

Specific nasal provocation tests in patients hypersensitive to mould allergens.

BACKGROUND: In the case of allergies to outdoor mould spores and plant pollen allergens, which are often concomitant, doubts may arise as to the role of mould allergens in inducing specific clinical manifestations. Establishing their significance is crucial for qualifying the patient for specific immunotherapy. This information also helps to reduce the percentage of therapeutic failures. MATERIAL/METHODS: The study population comprised 31 patients with seasonal allergic rhinitis who were allergic to both plant pollen allergens and mould spores. In each patient we performed a skin prick test, sIgE level determination, and a specific nasal provocation test using mould allergens, according to standard allergological diagnostic procedure, and the results were objectified using acoustic rhinometry. RESULTS: Positive NPT results were obtained in 22 patients. The positive results were more frequent in persons allergic to Cladosporium herbarum (92.3%) than in those allergic to Alternaria alternata (55.5%); these differences were statistically significant (p = 0.039). No differences were found between the two subgroups in terms of the sIgE levels (p = 0.13). In the study group as a whole, a high correlation between the results of acoustic rhinometry and the intensity of clinical manifestations was observed after administration of the NPT (correlation coefficient of 0.9). The correlation between the sIgE levels and the results of the skin prick tests and the NPT was much lower (0.48 and 0.66, respectively). CONCLUSIONS: The specific nasal provocation test is a safe and easy diagnostic modality, and acoustic rhinometry provides a good method of measuring it.